Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics
Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics
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DOI：
10.1093/cid/ciz1076
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发表时间：
2020-10-01
影响因子：
11.8
通讯作者：
Davis, Susan L.
中科院分区：
文献类型：
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作者：
Bianchini, Monica L.;Kenney, Rachel M.;Davis, Susan L.
背景门诊胃肠外抗菌治疗（OPAT）是一种广泛使用的，安全的，具有成本效益的治疗。大多数公共和私人保险提供商需要OPAT的事先授权（PA），但住院PA过程的影响尚不清楚。我们的目的是表征放电障碍和PA延迟与高价OPAT药物。这是一项在2017年1月至2017年12月期间接受达托霉素、头孢洛林、厄他培南和新型β-内酰胺-β-内酰胺酶抑制剂复方制剂出院的成人患者中进行的机构审查委员会批准的研究。将发生OPAL PA延迟的患者与未发生延迟的患者进行比较。主要终点是从治疗开始的直接住院总费用。纳入了200例患者：141例（71%）无OPAT延迟vs 59例（30%）OPAT延迟。与门诊患者相比，更多PA延迟患者出院至亚急性护理机构：37例（63%）vs 52例（37%），P = 0.001。OPAT延迟患者的出院延迟和直接住院总费用中位数更高：31（53%）vs 21（15%），P <0.001，19 576美元（四分位距[IQR]，10 056-37 038）vs 7770美元（IQR，3031-13 974），P <0.001。在多变量回归分析中，出院到亚急性护理机构与出院延迟的几率增加相关，年龄>64岁与出院延迟的几率降低相关。OPAT与高价抗生素需要大量的护理协调。PA延迟是常见的，并导致出院延迟。OPAT的护理过渡是一个机会，以改善病人的护理和解决访问障碍。
Background. Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics.Methods. This was an institutional review board-approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAL PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment.Results. Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P < .001 and $19 576 (interquartile range [IQR], 10 056-37 038) vs $7770 (IQR, 3031-13 974), P < .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age >64 years was associated with a decreased odds of discharge delay.Conclusions. OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.